What should be the code for this inflation?????????
Procedure and Findings:
With the patient in the supine position the left upper abdomen was
prepped and draped in the usual sterile fashion. The catheter was
flushed with sterile saline solution.Approximately 50 cc of
bilious fluid with clots was aspirated.Contrast examination
through the catheter demonstrates a nondilated collecting system
with small intralumenal filling defects consistent with clots.
The catheter was cut and exchanged over an Amplatz stiff guidewire
for a seven French sheath. The sheath was slowly withdrawn
proximally. Contrast injection along the tract demonstrates
opacification of left hepatic artery branches. In addition, a
collateral branch from the right hepatic artery appears to
reconstitute these vessels. A 5.5-French over-the-wire Fogarty
balloon catheter was then inflated along the tract between the
artery and the biliary system for approximately 15 minutes.
Following deflation, no further communication with the vessels is
noted. A 10 French VTCB biliary drainage catheter was then
replaced across the left biliary system. Gentle contrast
administration demonstrates proper catheter positioning.The
catheter was flushed with saline and aspirated until clear.The
catheter was sutured to the skin and connected to gravity
drainage. The patient tolerated the procedure without incident.
Impression: Catheter cholangiogram demonstrates persistent
arterial biliary fistula as described above. Previously embolized
vessels are apparently reconstituted via communication with right
hepatic artery branches. However, arterial evaluation is limited
on this examination.
Successful temporary tamponade of arterial biliary fistula using a
5.5-French over-the-wire Fogarty balloon as described above. New
10 French VTCB biliary drainage catheter was replaced across the
left biliary tree and the left to external drainage as described
above.
Procedure and Findings:
With the patient in the supine position the left upper abdomen was
prepped and draped in the usual sterile fashion. The catheter was
flushed with sterile saline solution.Approximately 50 cc of
bilious fluid with clots was aspirated.Contrast examination
through the catheter demonstrates a nondilated collecting system
with small intralumenal filling defects consistent with clots.
The catheter was cut and exchanged over an Amplatz stiff guidewire
for a seven French sheath. The sheath was slowly withdrawn
proximally. Contrast injection along the tract demonstrates
opacification of left hepatic artery branches. In addition, a
collateral branch from the right hepatic artery appears to
reconstitute these vessels. A 5.5-French over-the-wire Fogarty
balloon catheter was then inflated along the tract between the
artery and the biliary system for approximately 15 minutes.
Following deflation, no further communication with the vessels is
noted. A 10 French VTCB biliary drainage catheter was then
replaced across the left biliary system. Gentle contrast
administration demonstrates proper catheter positioning.The
catheter was flushed with saline and aspirated until clear.The
catheter was sutured to the skin and connected to gravity
drainage. The patient tolerated the procedure without incident.
Impression: Catheter cholangiogram demonstrates persistent
arterial biliary fistula as described above. Previously embolized
vessels are apparently reconstituted via communication with right
hepatic artery branches. However, arterial evaluation is limited
on this examination.
Successful temporary tamponade of arterial biliary fistula using a
5.5-French over-the-wire Fogarty balloon as described above. New
10 French VTCB biliary drainage catheter was replaced across the
left biliary tree and the left to external drainage as described
above.